间歇经口至食管管饲法对延髓背外侧综合征所致吞咽障碍病人的临床观察

目的:观察间歇经口至食管管饲(IOE)法对延髓背外侧综合征所致吞咽障碍病人的临床疗效,为该类病人寻找新的治疗方法。方法:将符合入选标准的延髓背外侧综合征病人60例,按入院顺序随机分入IOE组和鼻胃管(NGT)组,每组各30例。两组病人均在控制基础疾病、干预可控危险因素和脑卒中预防用药的治疗基础上给予吞咽功能训练。在治疗期间,两组病人分别采用IOE法和NGT法给予肠内营养(EN)支持。同时,对两组病人入院24 h内和治疗6周后的营养指标和吞咽功能改善情况进行差异性分析。结果:IOE组病人在治疗6周后营养指标和吞咽功能与NGT组比差异均有显著性统计学意义(P0.05)。结论:IOE法较NGT法更有利于促进延髓背外侧综合征病人的吞咽功能改善。     

康复训练联合间歇经口至食管管饲法IOE对吞咽障碍患者的康复治疗与观察

目的探讨康复训练联合间歇经口至食管管饲法IOE对吞咽障碍患者的康复治疗。方法选取在我院康复医学科采用康复治疗干预的60例脑卒中吞咽障碍患者。一组为对照组,另一组为实验组,每组各30例患者。对照组采用康复手法常规训练吞咽功能。实验组采用康复训练联合间歇经口至食管管饲法训练吞咽功能,内容包括康复吞咽评定、进食体位护理、吞咽置管康复指导等。然后对比两组洼田饮水以及患者吞咽功能。结果实验组的临床效果优于对照组,差异具有统计学意义(P<0.05);结论康复训练联合间歇口腔食管管饲法对脑卒中有吞咽障碍的患者,给予科学的康复训练,能够有效地改善患者的生活能力和生活质量,促进患者病情恢复,临床应用价值和意义重大,减轻患者的痛苦,从而减轻家庭负担,值得临床实施和推广。     

间歇经口插管吞咽—摄食管理在脑卒中吞咽障碍患者中的应用效果观察

目的:观察间歇经口插管吞咽—摄食管理在脑卒中吞咽障碍患者中的应用效果。方法:选取2016年6月～2018年3月收治的脑卒中吞咽障碍患者80例为研究对象,采用随机数表法分为观察组和对照组各40例,对照组给予常规持续性管饲胃肠营养法(PNG),观察组给予间歇经口插管吞咽辅助患者进食,记录治疗前后两组吞咽康复情况,比较治疗效果及不良反应。结果:治疗前两组蛙田饮水试验分数及VGF分数比较无统计学意义(P0.05),治疗后两组蛙田饮水试验分数均较治疗前下降,且观察组分数低于对照组,差异有统计学意义(P0.05),VGF评分均较治疗前升高,且观察组分数高于对照组,差异有统计学意义(P0.05);观察组治疗有效率97.50%高于对照组85.00%,差异有统计学意义(P0.05);观察组不良反应发生率2.50%(1/40)低于对照组7.50%(3/40),差异无统计学意义(P0.05)。结论:间歇经口插管吞咽辅助脑卒中吞咽障碍患者进食疗效较佳,安全有效,值得在临床上推广。     

导管球囊扩张术联合间歇性经口至食管管饲营养法治疗环咽肌失弛缓的疗效观察

目的:研究导管球囊扩张术联合间歇性经口至食管管饲营养法(IOE)治疗环咽肌失弛缓的临床疗效.方法:将符合标准40例脑损伤后环咽肌失弛缓造成吞咽障碍的患者分为观察组(20例)和对照组(20例),两组均给予包括基础药物及常规吞咽治疗在内的治疗,观察组给予导管球囊扩张治疗,并通过IOE方式进食,对照组则只给予导管球囊扩张术,...     

胃肠外营养支持对乳腺癌病人术后营养和免疫功能的影响

目的:探讨胃肠外营养支持在乳腺癌病人术后康复过程中的临床作用和安全性. 方法:将80例乳腺癌手术病人随机分为对照组(行普通治疗)和观察组(行肠外营养支持).通过检测两组病人术前和术后的各项营养指标和免疫指标的变化,对两种治疗方式进行比较. 结果:观察组病人术后第7天各项营养指标和免疫功能指标均较对照组改善,差异有显著性意义(P＜0.05). 结论:胃肠外营养可有效地改善乳腺癌病人术后机体的营养状况和免疫功能,对后期的综合治疗有着重要的临床意义.     

经鼻空肠管早期肠内营养在重症胸外伤老年病人中的应用

目的:探讨经鼻空肠管早期肠内营养(EEN)在伴呼吸功能衰竭的重症胸外伤老年病人中的应用.方法:将42例伴呼吸功能衰竭的重症胸外伤老年病人随机分为试验组和对照组.试验组经鼻空肠管行EEN;对照组病人早期给予全胃肠外营养(TPN)支持,比较两组营养、炎症、免疫和临床观察各项指标.结果:两组病人在机械通气开始时营养、炎症、免疫指标均无显著性差异.经营养支持后,试验组病人营养指标和免疫功能指标均优于对照组(P＜0.05,P＜0.01),炎症指标均低于对照组(P＜0.05,P＜0.01);病死率、肺部感染率和机械通气时间显著低于对照组(P＜0.01).结论:伴呼吸功能衰竭的重症胸外伤老年病人经鼻空肠管EEN安全可行,可提高免疫功能,改善营养状况,减轻炎症反应,减少伤后并发症的发生率,从而提高生存率.     

危重症患者胃肠内与胃肠外营养支持疗效观察

目的 观察胃肠内与胃肠外营养支持对危重症（ICU）患者的治疗效果,探讨两种营养支持途径的临床价值.方法 危重症患者60例,随机分为胃肠道营养组30例和胃肠外营养组30例.在治疗前及治疗15 d后对两组患者血红蛋白、总蛋白、清蛋白等营养指标进行比较.结果 胃肠道营养组治疗后各项指标较治疗前增高,差异有统计学意义 （P〈0 05）;胃肠外营养组治疗后各项指标较治疗前增高,但差异无统计学意义（P〉0 05）.两组治疗后清蛋白比较,差异具有统计学意义（P〈0 05）.结论 胃肠内营养支持能较好的改善患者营养状况,是危重患者的理想支持方式.     

经皮内镜下胃造口置管术对脑卒中后吞咽障碍病人生活质量的影响

目的:观察和比较经皮内镜下胃造口置管术(PEG)和置入鼻胃管(NGT)两种肠内营养(EN)途径对脑卒中后吞咽障碍病人生活质量的影响. 方法:选取脑卒中后吞咽障碍需长期EN治疗的病人74例,根据病人和家属选择分为PEG组(n=24)和NGT组(n=50),分别在EN治疗第1、2和3个月后采用SF-36(the MOS 36-item short-form health survey)量表和微型营养评价法(MNA)对病人进行生活质量评价和营养评估,并观察其并发症.结果:PEG组EN治疗1个月后生活质量未见改善(P＞0.05);2个月和3个月后生活质量均明显改善(P＜0.05),且均优于NGT组(P＜0.05).EN治疗1、2和3个月后,两组病人的营养状况均明显改善(P＜0.05).两组病人吸人性肺炎的发生率无显著性差异(P＞0.05),但营养治疗的失败率PEG组低于NGT组(P＜0.05). 结论:脑卒中后吞咽障碍需长期EN的病人,PEG有利于改善生活质量,并能改善营养状况,降低营养治疗的失败率.     

围手术期营养支持在胰十二指肠切除术病人的临床应用

目的:比较胰十二指肠切除术病人围手术期肠内营养(EN)与肠外营养(PN)支持的效果. 方法:60例胰十二指肠切除捆绑式胰肠吻合术后病人随机分为全肠内营养(TEN)组和完全胃肠外营养(TPN)两组,每组各30例.手术前3 d开始给予营养支持,TEN组口服百普素,术后24 h内开始经空肠造口管输注;TPN组术前3 d开始经腔静脉置管行PN支持,术后24 h恢复TPN支持,两组营养支持时间均为14 d. 结果:两组病人均完成营养支持计划,未发生吻合口瘘和腹腔感染.两组病人术后的体质量、体质指数、上臂周径均较术前略低,但组间比较无显著性差异(P＞0.05).两组病人血清蛋白水平在手术后均有明显下降,TPN组下降更明显,组间比较有显著性意义(P＜0.05).TPN组术后谷酰转肽酶和乳酸脱氢酶高于TEN组.术后监测氮平衡1周,两组均表现为负氮平衡.TEN、TPN组肠功能恢复时间分别为(2.5±0.5) d和(3.0±0.5) d(P＜0.05).术后排便时间分别为(4.0±1.0) d和(6.0±1.0) d(P＜0.01).两组病人住院天数无显著性差异(P＞0.05),但TEN组伤口愈合情况优于TPN组(P＜0.05),平均住院费用/药物费用TEN、TPN组分别为11 206/4 502元、15 430/7 500元(P＜0.05). 结论:对胰十二指肠切除术病人,术前3 d及术后早期行EN,可改善营养状况,降低蛋白质分解,促进肠功能恢复,符合生理需求.     

高支链氨基酸肠内营养对术后肝功能不全病人影响的临床观察

目的:观察高支链氨基酸肠内营养(EN)制剂对术后肝功能不全病人肝功能及营养代谢疗效和安全性. 方法:选择术后肝功不全伴低蛋白血症的病人50例,随机分为两组,观察组28例病人用高支链氨基酸EN制剂治疗,对照组22例病人用整蛋白全营养型EN支持治疗.分别于治疗第7和第14天,观察肝功能、营养状况的变化. 结果:两组病人营养支持治疗后的血清总蛋白、清蛋白、前清蛋白、转铁蛋白均显著高于EN支持治疗前(P＜0.01).观察组病人营养支持第14天前清蛋白显著高于对照组(P＜0.05).两组病人应用营养支持治疗后肝功能各项指标均有显著改善(P＜0.05). 结论:高支链氨基酸能有效地改善术后肝功能不全病人的营养状况和肝功能.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.